Inflammatory biomarkers as predictors of systemic vs isolated pocket infection in patients undergoing transvenous lead extraction

BackgroundCardiovascular implantable electronic device (CIED) infections are a common indication for device extraction. Early diagnosis and complete system removal are crucial to reduce morbidity and mortality. The lack of clear infectious symptoms makes the diagnosis of pocket infections challenging and may delay referral for extraction.ObjectiveWe aim to determine if inflammatory biomarkers can help diagnose CIED isolated pocket infection.MethodsWe performed a retrospective analysis of all patients undergoing transvenous lead extraction for CIED infection at UCSD from 2012 to 2022 (n= 156). Patients were classified as systemic infection (n=88) or isolated pocket infection (n=68). Prospectively collected pre-operative procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) were compared between groups.ResultsPairwise comparisons revealed that the systemic infection group had a higher PCT than the control group (p<0.001), and the pocket infection group (p=0.009). However, there was no significant difference in PCT value between controls and isolated pocket infection subjects. Higher WBC was only associated with systemic infection when compared to our control group (p=0.018).ConclusionIn patients diagnosed with CIED infections requiring extraction, inflammatory biomarkers were not elevated in isolated pocket infection. Inflammatory markers are not predictive of the diagnosis of pocket infections, which ultimately requires a high level of clinical suspicion.